Differential Diagnosis for Hypertension

Given the blood pressure reading of 180/100 in an unmedicated individual, it's crucial to explore the potential causes and take appropriate measures. Here's a structured approach to the differential diagnosis:

• Single Most Likely Diagnosis

  • Essential Hypertension: This is the most common cause of hypertension, accounting for about 90-95% of cases. It is a diagnosis of exclusion, meaning that after evaluating for other causes, if none are found, essential hypertension is considered. Lifestyle factors, genetics, and age can contribute to its development.

• Other Likely Diagnoses

  • Chronic Kidney Disease (CKD): CKD can cause hypertension due to fluid overload, sodium retention, and activation of the renin-angiotensin-aldosterone system. The kidneys' ability to regulate blood pressure is impaired in CKD.
  • Sleep Apnea: This condition is associated with hypertension, possibly due to intermittent hypoxia, increased sympathetic activity, and inflammation.
  • Primary Aldosteronism: A condition where the adrenal glands produce too much aldosterone, leading to sodium retention, water retention, and high blood pressure.
  • Thyroid Disorders: Both hyperthyroidism and hypothyroidism can lead to hypertension, though the mechanisms differ. Hyperthyroidism increases cardiac output, while hypothyroidism may lead to increased peripheral resistance.

• Do Not Miss Diagnoses

  • Pheochromocytoma: A rare tumor of the adrenal gland that secretes catecholamines, leading to episodic or sustained hypertension. Missing this diagnosis can be fatal due to the risk of hypertensive crises.
  • Aortic Coarctation: A narrowing of the aortic isthmus, which can cause severe hypertension in the arms, with potentially lower pressures in the legs. It's crucial to diagnose this condition to prevent complications like heart failure and aortic dissection.
  • Renal Artery Stenosis: Narrowing of the arteries that supply blood to the kidneys, which can activate the renin-angiotensin-aldosterone system and cause hypertension.

• Rare Diagnoses

  • Cushing's Syndrome: A condition caused by excess cortisol, which can lead to hypertension among other symptoms like weight gain and glucose intolerance.
  • Hyperparathyroidism: Elevated parathyroid hormone levels can lead to hypertension, possibly through effects on calcium and phosphate metabolism and vascular smooth muscle.
  • Acromegaly: Excess growth hormone, usually due to a pituitary tumor, can cause hypertension, possibly through effects on cardiac output and vascular resistance.

For the individual with a blood pressure of 180/100, the immediate steps should include:

• Consulting a healthcare provider for a thorough evaluation.
• Undergoing basic tests such as urine analysis, blood tests for kidney function, electrolytes, and possibly thyroid function.
• Considering lifestyle modifications such as diet, exercise, and stress management.
• Potentially starting antihypertensive medication, depending on the healthcare provider's assessment and guidelines.

Given the potential for serious complications, prompt medical evaluation is essential to determine the underlying cause of the hypertension and to initiate appropriate treatment.